Has your child had a two year development check with their Health Visitor? (NOTE: If yes please bring with you to your settle in day).

YES

NO

**

Section Two - Things We May Need to Know

Our role is to ensure the children in our care are safe and happy and to do that it helps if we have as much family and background information as possible. So please use this space to tell us anything you think is necessary ie. adoption/fostering/parents no longer together/parents deceased. Please do not use this space for routine/comfort details, please inform us at your visit:

ALL INFORMATION PROVIDED WILL REMAIN PRIVATE & CONFIDENTIAL

Section Three - Additional Information

Please inform us of any additional information we need to be aware of, ie. people who are not authorised to collect the child (please discuss at your visit with more details if required): Please do not use this space for routine/comfort details, we will log this separately on your visit:

Section Four - Medical Information

Part 1 - Doctor Contact Information

Doctor's Name **

Surgery Name **

Telephone **

End of section one

DOES YOUR CHILD HAVE ANY MEDICAL CONDITIONS? (Please specify)

Section Five - Allergies and Special Dietary Requirements

DOES YOUR CHILD HAVE ANY ALLERGIES? (Please specify)

ACTION TO BE TAKEN?

DOES YOUR CHILD HAVE ANY DIETARY REQUIREMENTS? (due to religion, family preference, way of life, health status, etc - please specify)

End of section one

C - General Information and Confirmations

Section One - Please Tell Us Where You Heard About Wise Owls?

Word of Mouth?

Newspaper/Magazine?

Other?

Which News/Mag?

What Other?

End of section one

Section Two - Please Read Carefully and Complete ALL Parts

I agree that photos/video recordings of my child can be taken for advertising purposes, ie: posters, wall displays, our website, social networking sites such as Facebook / Twitter, newspaper pieces:

YES

NO

**

I understand that emergency services may be contacted during the running of the Nursery if thought appropriate. I understand that the play care staff are authorised to sign any written forms of consent required by the hospital authorities if my child’s life is in danger. I understand that first aid treatment may be carried out on my child by a first aid trained member of staff:

Agreed

**

I have read the Wise Owls at Farm View Day Nursery Terms and Conditions and Policies and Procedures and acknowledge that I am bound by these. These are subject to change, but you will be informed if they are. The most current version will be on the website.

I understand to the best of my knowledge that the information provided in this form is correct and that as the main carer of the child it is my duty to ensure it is up to date and correct at all times.